Mild osteoporosis DEXA scores: what would you do?

Thanks for mentioning HRT, I'm also curious. It was never brought up to me until recently except to scare me away after the WHI study. I've heard you can't take them after 59, or 10 yrs past menopause. I'm 57, seven years past menopause, -2.6 femoral neck. If I tried HRT would I have to stop in two years and my bone density would drop? I.e., does it give any lasting benefit or only delay the inevitable by two years?

Yes and yes! I wish I had too! Obgyn recommended, bio identical, endo said no, bad info, based on outdated studies.
I’d love to know what doses hrt you’re using to maintain! I’ve read so much. Easier to find dosing for estrogen than testosterone. Really frustrating.

It would be an option for you to explore. There are risks in taking any medication whether they are osteoporosis meds or hormones so you have to decide which risk you are most comfortable with. There's also the "do nothing" or "diet and exercise" approach which risks further bone loss and fracture. These are really tough decisions for each of us to make. Personally, I chose pharmaceuticals that I felt were most "natural" to the body after a failed diet and exercise approach led me to go from -2.8 in my spine to -3.2. I knew I needed a bone builder at that point and since Forteo was synthetic parathyroid hormone, and mostly built spine where I had all of my loss (typical of bone loss progression, from spine first to hip secondarily), I felt that it was something the body was accustomed to and recognized. The same with hormones. I am replacing something that was natural to my body and that maintains bone in a natural way so I chose that after Forteo to maintain the gains. Hormones were once readily prescribed for osteoporosis but that changed after the results of the WHI study were widely publicized and vastly misrepresented. You can still get a prescription for HRT from your gynecologist for "menopause symptoms". If they are reluctant, you can use an online service such as Alloy Health if you are in the USA. They have MDs on staff who are menopause specialists and will evaluate your situation and prescribe a dose they feel is appropriate. You do this all by email. There are no fees unless you chose to proceed with a prescription and then you are charged for the medication only. If you want a more in-depth consultation with a physician, that is available for a $35 fee and is done through private messaging on their website. The lowest dose of transdermal estradiol is .025 which is also considered the safest and is a dose that is likely sufficient to stem bone loss. I was on that dose for 5 years. I've had only the slightest loss in all that time so I just increased my dose to .0375 as a further safeguard. If you have a uterus, you must be on progesterone as well and the safest option is bioidentical progesterone, not synthetic progestin. The typical dose prescribed is 100 mg oral.

Here are some options for you to read further:
Estrogen Matters by Dr Avrum Bluming
https://evidence.nihr.ac.uk/alert/risk-of-breast-cancer-with-hrt-depends-therapy-type-and-duration/

I was on .025 transdermal estrogen. That is the lowest dose and it has been shown to maintain density. After 5 years, I recently increased to .0375. I am currently seeing a menopause specialist and she wanted me to go to .05 but I was reluctant as I was concerned about the potential for breast tenderness and enlargement so I compromised with .0375. She felt that the slightly higher dose would provide a greater benefit. I've had no body changes or side effects on the new dose. It is still considered a very low dose. I have looked into testosterone and at this point, it seems that it is not recommended for women except in the case of low libido. There is little to no research on women taking it for osteoporosis. In addition, testosterone is processed and converted to estrogen so personally, I am not comfortable taking it and was recommended against it by my menopause specialist who has been prescribing HRT for decades.

I think the original poster subsequently posted that the endocrinologist advised her that HRT was not an option. Perhaps as a first step, the basis of that medical opinion should be fully understood.

What doctors have you seen and where are they located?

I was on .025 transdermal estrogen. That is the lowest dose and it has been shown to maintain density. After 5 years, I recently increased to .0375. I am currently seeing a menopause specialist and she wanted me to go to .05 but I was reluctant as I was concerned about the potential for breast tenderness and enlargement so I compromised with .0375. She felt that the slightly higher dose would provide a greater benefit. I've had no body changes or side effects on the new dose. It is still considered a very low dose. I have looked into testosterone and at this point, it seems that it is not recommended for women except in the case of low libido. There is little to no research on women taking it for osteoporosis. In addition, testosterone is processed and converted to estrogen so personally, I am not comfortable taking it and was recommended against it by my menopause specialist who has been prescribing HRT for decades.

Thanks for this. I've heard same about testosterone. I highly recommend the Vajenda by Dr. Jen Gunter, she has a lot to say about unregulated bioidentical hormones, and testosterone.